It’s all about the levels

The notion that the arousal we experience during stressful events is useful, not least because it allows us to categorise stress in terms of levels, from low-level positive stress through to the kind of stress that makes us ill and negatively impacts all manner of life. Positive stress is a useful type of stress in that it motivates and promotes buoyancy. This kind of stress is brief and often quite mild as far as stressful events go and causes only minor physiological and hormonal changes. Most importantly, and in relation to the classic resilience research discussed in Chapter 2, positive stress can be buffered by the presence of supportive and caring people. Through this positive relationship, healthy development within the environment can be promoted.

Often when we talk of stressful events, we are in the region of tolerable stress, those adverse experiences we all suffer from time to time such as family disruption and even the death of a loved one. These events can produce more intense, short-lived stress that is manageable yet painful. Again, the support of friends and family and other systems in general are vital if we are to prevent tolerable stress morphing into something more sinister. Some kind of stress management in therefore important if people are to move past these often intensely painful experiences.

The term toxic stress was first coined by paediatrician Jack Shonkoff at the Center of the Developing Child, Harvard University This is a more extreme type of stress linked to adverse childhood experiences (or ACEs). It's a chronic, excessive type of stress that exceeds the child's ability to cope, most acutely in the absence of a supportive adult. In cases of toxic stress, the fight or flight response can last weeks, months and even years, leading to permanent emotional and developmental damage (Garner et al., 2012).

Our final type of stress is known as allostatic load and was coined by Bruce McEwen and Eliot Stellar of Yale University (McEwen & Stellar, 1993). Allostatic load refers to the wear and tear on the body that accumulates as we are exposed to repeated chronic stress. This doesn't relate to a specific stressful event, but rather the gradual grinding down of our ability to cope, struggling from one stressful situation to another until we can no longer recover from even the smallest of setbacks.

Causes of stress in children and young people

It's safe to say that many of the stressors experienced by children and young people are the same ones experienced by adults. Nevertheless, children are more likely to find themselves as passive recipients of stress. We can see this in the case of home life, in that home-based stressors rarely involve children directly. Early research into childhood stressors is sparse and has tended to investigate factors related to attachment and maternal deprivation. This included the pioneering work of James and Joyce Robertson and their investigation into the behaviour displayed by very young children who were hospitalised, as well as studies into parental divorce and separation and how first-borns react to the birth of a sibling.

The reaction of very young children to a stay in hospital has changed over the years, and today's parents might be aware that hospitals often bend over backwards to accommodate mums and dads. This, however, has not always been the case. In 1952 James Robertson filmed the distress young children experienced when parted from their family, resulting in the now classic A Two- year-old Goes to Hospital (see, for example, Alsop-Shields & Mohay, 2001). This 80-minute black and white footage has since been designated as of national and historic importance and preserved in the National Archives. This and later work began to inform hospital policy, abandoning visiting hours and allowing parents to remain with their children throughout their stay.

What we learned from this and other research is that separation from a maternal figure can be incredibly traumatic, with the most extreme distress occurring in children between six months and four years of age. This age range represents the time when selective attachments are being formed but is also the time when children are only just beginning to be able to maintain relationships during periods of separation. Daily visits by a parent or sibling (and any familiar face) can reduce this distress and a supporting relationship from a consistently present nurse (rather than several different nurses) can help to reduce this emotional disturbance. The main causes of the distress are therefore the separation from the attachment figure and the lack of opportunity to form new attachments.

Early research into the birth of a sibling is less readily available, although Terence Moore did conduct a small-scale study that found around 15 per cent of children developed some kind of social or emotional difficulty following the birth (see Mercer, 2011). Judy Dunn, in a later study, also found that these children did display heightened behavioural and emotional difficulties, including becoming more tearful, sleeping difficulties and toileting problems (see Mercer, 2011). The impact of parental divorce and separation is better understood, although Michael Rutter concluded that disturbance is much more likely to result from a prolonged period of disharmony rather than divorce itself (see Mercer, 2011).

Since this early research, a number of other factors have been identified as causes of stress in young people. These range from the family problems and parental addiction and incarceration, mental and physical illness, emotional and physical neglect and exposure to violence. Of particular relevance are the school or academic related stressors: being over scheduled, feeling pressured to perform or behave beyond individual limits, difficulty with school work and being bullied. There is also evidence suggesting that some groups are more vulnerable to the majority of these stressors, particularly children from lower socio-economic backgrounds (see Garmezy & Rutter, 1988 for an in-depth discussion of these studies).

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